Digital subtraction arthrography in preoperative evaluation of painful total hip arthroplasty

 Objective. The objective of this clinical study was to define the diagnostic value of plain radiography, digital subtraction arthrography and two-phase bone scintigraphy in patients with clinically loose or infected hip prostheses. Design. Digital subtraction arthrograms, scintigrams and plain radiographs of 70 consecutive patients who underwent revision hip arthroplasty were scored individually and in masked fashion for the presence or absence of features indicating loosening of femoral and/or acetabular components. The operative findings acted as the gold standard. Results. Digital subtraction arthrography was best (P<0.001) for predicting a loose acetabular component, while no significant additional predictive value was found for plain radiographs (P=0.24) and scintigraphy (P=0.27). Digital subtraction arthrography was also the most important modality for predicting a loose femoral component (P=0.001), while the plain radiograph was of significant (P=0.04) additional value and scintigraphy was of no additional value (P=0.13) on multivariate analysis. Conclusion. Digital subtraction arthrography gives the best results in the prediction of loosening of acetabular and femoral components. Plain radiographs give additional information on loosening of the femoral component, but scintigraphy offers no additional advantage.     

Use of the fluid column in a cardiac catheter for emergency pacing

Given the not infrequent need for intracardiac pacemaking during intensive cardiac care, a new type of cardiac pacemaker has been designed and tested [1]. With this pacemaker the heart can be stimulated through the fluid column of any conventional catheter, provided it is filled with a 0.9% NaCl solution. This fluid column pacemaker (FCP) is of the “constant current” type. The FCP was tested in 37 animals, in 30 patients in sinus rhythm, and also in two critical patients. In addition to the pacemaker circuit, a special connector was designed, enabling a fast, effective, and safe contact between patient and pacemaker. The FCP is considered to be ideally suited for use in emergency cardiac pacing in intensive care units and other areas where sudden bradycardias may occur and where intrathoracic catheters are inserted for a variety of reasons.     

A cytogenetic study of a mentally retarded population in South Africa.

The entire population of the Umgeni Waterfall Institution for mentally retarded Whites was karyotyped using aceto-orcein and ASG banded preparations. Of the 512 subjects, 376 were males and 136 were females. Their ages ranged from 1 to 72 years and mental retardation ranged from borderline to profound. Altogether 11,1% had chromosome abnormalities, of which 8,2% had trisomy-21, 1,9% had other autosome abnormalities, and sex chromosome anomalies occurred in 1%. Normal variant chromosomes were seen in 4,5% of the population. Problems that arose in the course of the survey were mainly due to inadequate family histories and the high proportion of cases in which contact with the family had been lost, thus precluding proper follow-up studies.     

Hereditary fructose intolerance: a difficult diagnosis in the adult.

A 21 year old woman presented with viral meningitis and was treated parenterally with fructose-containing solutions. A dramatic clinical picture developed consisting of an acute lcterus, complicated by severe gastrointestinal hemorrhagic episodes, hypoglycemia and a pronounced proximal tubular acidosis. A syndrome of disseminated intravascular coagulation was documented. The presence of a Fanconi syndrome characterized by an important bicarbonaturia, glycosuria, aminoaciduria and a markedly decreased phosphate reabsorption led to the correct diagnosis of a previously unknown hereditary fructose intolerance. All symptoms of the Fanconi syndrome disappeared within 48 hours after the intravenous administration of fructose was stopped. The hepatic dysfunction, however, lasted for three months.After recovery, a decreased liver fructose-1-phosphate-aldolase was found. An intravenous fructose tolerance test was subsequently performed: within 60 minutes after initiation of the fructose infusion, plasma bicarbonate ion (HCO₃^?) decreased from 25 to 14 meq/liter and the urinary HCO₃^? excretion increased from 10 to 111 μeq/min. Plasma phosphate decreased from 4.4 to 2.6 mg/100 ml, concomitantly with an increase in renal phosphate clearance from 9 to 20 ml/min. Both plasma uric acid and urinary uric acid excretion increased from 3.2 to 6.7 mg/100 ml and from 0.3 to 1.98 mg/min, respectively. Plasma parathyroid hormone (PTH) levels remained unchanged whereas the urinary cyclic AMP excretion decreased during fructose administration. Biochemical evidence of hepatic dysfunction was present. All parameters normalized within three hours after withdrawal of the fructose.Although exceptional, this case illustrates that “routine” administration of fructose-containing solutions can provoke a dramatic clinical situation in patients with unknown hereditary fructose intolerance. The occurrence of a proximal tubular acidosis may alert for the existence of this disorder.     

Gastrothorax mimicking acute tension pneumothorax

We describe a case of respiratory failure due to an acute tension gastrothorax in an elderly patient, secondary to an episode of vomiting. Initially the scout view was interpreted as a tension pneumothorax. Eventually the computed tomography (CT) of the thorax revealed a transdiaphragmatical herniation of the stomach and other visceral organs. An endoscopic desufflation procedure was performed, leading to improvement of the vital signs. Consequently, surgical repair was performed. It is important to be aware of specific radiologic signs, suggesting that the intrathoracic air collection is not caused by a pneumothorax. The initial treatment of a tension gastrothorax is nasogastric or orogastric decompression.     

The relation between public speaking anxiety and social anxiety: A review

This article reviewed the literature on public speaking anxiety in the context of social phobia subtyping. In total, 18 empirical studies on subtype issues related to public speaking anxiety were analyzed. Results of the reviewed studies are discussed in relation to their research method, that is, whether it focused on qualitative or quantitative aspects of subtype differences and whether it used a clinical or community sample. Evidence supported the premise that public speaking anxiety is a distinct subtype, qualitatively and quantitatively different from other subtypes of social phobia. The significance of this finding for social phobia studies using speech tasks to assess participants’ state anxiety and behavioral performance is discussed.